IMPORTANCE Limited data exist regarding the association of subtle subclinical systolic dysfunction and incident heart failure (HF) in late life.OBJECTIVE To assess the independent associations of subclinical impairments in systolic performance with incident HF in late life. DESIGN, SETTING, AND PARTICIPANTSThis study was a time-to-event analysis of participants without heart failure in the Atherosclerosis Risk in Communities (ARIC) study, a prospective, community-based cohort study, who underwent protocol echocardiography at the fifth study visit (January 1, 2011, to December 31, 2013. Findings were validated independently in participants in the Copenhagen City Heart Study (CCHS). Data analysis was performed from June 1, 2018, to February 28, 2020.EXPOSURES Left ventricular ejection fraction (LVEF), longitudinal strain (LS), and circumferential strain (CS) measured by 2-dimensional and strain echocardiography.MAIN OUTCOMES AND MEASURES Main outcomes were incident adjudicated HF and HF with preserved and reduced LVEF at a median follow-up of 5.5 years (interquartile range, 5.0-5.8 years). Cox proportional hazards regression models adjusted for demographics, hypertension, diabetes, obesity, smoking, coronary disease, estimated glomerular filtration rate, LV mass index, e′, E/e′, and left atrial volume index. Lower 10th percentile limits were determined in 374 participants free of cardiovascular disease or risk factors. RESULTS Among 4960 ARIC participants (mean [SD] age, 75 [5] years; 2933 [59.0%] female; 965 [19%] Black), LVEF was less than 50% in only 76 (1.5%). In the 3552 participants with complete assessment of LVEF, LS, and CS, 983 (27.7%) had 1 or more of the following findings: LVEF less than 60%, LS less than 16.0%, or CS less than 23.7%. Modeled continuously or dichotomized, worse LVEF, LS, and CS were each independently associated with incident HF. The adjusted hazard ratio (HR) per SD decrease in LVEF was 1.41 (95% CI, 1.29-1.55); the HR for LVEF less than 60% was 2.59 (95% CI, 1.99-3.37). Similar findings were observed for continuous LS (HR, 1.37; 95% CI, 1.22-1.53) and dichotomized LS (HR, 1.93; 95% CI, 1.46-2.55) and for continuous CS (HR, 1.39; 95% CI, 1.22-1.57) and dichotomized CS (HR, 2.30; 95% CI, 1.64-3.22). Although the magnitude of risk for incident HF or death associated with impaired LVEF was greater using guideline (HR, 2.99; 95% CI, 2.19-4.09) compared with ARIC-based limits (HR, 1.88; 95% CI, 1.58-2.25), the number of participants classified as impaired was less (104 [2.1%] based on guideline thresholds compared with 692 [13.9%] based on LVEF <60%). The population-attributable risk associated with LVEF less than 60% was 11% compared with 5% using guideline-based limits, a finding replicated in 908 participants in the CCHS.CONCLUSIONS AND RELEVANCE These findings suggest that relatively subtle impairments of systolic function (detected based on LVEF or strain) are independently associated with incident HF and HF with reduced LVEF in late life. Current recommended assessments of LV functio...

ImportanceFood insecurity disproportionately affects Black individuals in the US. Its association with coronary heart disease (CHD), heart failure (HF), and stroke is unclear.ObjectiveTo evaluate the associations of economic food insecurity and proximity with unhealthy food options with risk of incident CHD, HF, and stroke and the role of diet quality and stress.Design, Setting, and ParticipantsThis cohort study was a time-to-event analysis of 3024 Black adult participants in the Jackson Heart Study (JHS) without prevalent cardiovascular disease (CVD) at visit 1 (2000-2004). Data analysis was conducted from September 1, 2020, to November 30, 2021.ExposuresEconomic food insecurity, defined as receiving food stamps or self-reported not enough money for groceries, and high frequency of unfavorable food stores (&amp;gt;2.5 unfavorable food stores [fast food restaurants, convenience stores] within 1 mile).Main Outcomes and MeasuresThe main outcomes were incident CVD including incident CHD, stroke, and HF with preserved ejection fraction and with reduced ejection fraction (HFrEF). During a median follow-up of 13.8 (IQR, 12.8-14.6) years, the associations of measures of food inadequacy with incident CVD (CHD, stroke, and HF) were assessed using multivariable Cox proportional hazards regression models.ResultsAmong the 3024 study participants, the mean (SD) age was 54 (12) years, 1987 (66%) were women, 630 (21%) were economically food insecure, and 50% (by definition) had more than 2.5 unfavorable food stores within 1 mile. In analyses adjusted for cardiovascular risk and socioeconomic factors, economic food insecurity was associated with higher risk of incident CHD (hazard ratio [HR], 1.76; 95% CI, 1.06-2.91) and incident HFrEF (HR, 2.07; 95% CI, 1.16-3.70), but not stroke. These associations persisted after further adjustment for diet quality and perceived stress. In addition, economic food insecurity was associated with higher high-sensitivity C-reactive protein and renin concentrations. High frequency of unfavorable food stores was not associated with CHD, HF, or stroke.Conclusions and RelevanceThe findings of this cohort study suggest that economic food insecurity, but not proximity to unhealthy food options, was associated with risk of incident CHD and HFrEF independent of socioeconomic factors, traditional cardiovascular risk factors, diet quality, perceived stress, and other health behaviors. Economic food insecurity was also associated with markers of inflammation and neurohormonal activation. Economic food insecurity may be a promising potential target for the prevention of CVD.

IMPORTANCESparse data exist regarding the contributions of subclinical impairments in cardiovascular and noncardiovascular function to incident heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) among Black US residents, limiting understanding of the etiology of HF subtypes. OBJECTIVES To identify subclinical cardiovascular and noncardiovascular risk factors associated with HFrEF and HFpEF in Black US residents. DESIGN, SETTING, AND PARTICIPANTS This cohort study used cross-sectional and time-to-event analysis with data from the community-based Jackson Heart Study (JHS), a longitudinal cohort study with baseline data collected from 2000 to 2004 (visit 1) and 10-year follow-up for incident HF. Black US residents from the Jackson, Mississippi, metropolitan area enrolled in JHS; those with prevalent HF, with moderate or greater aortic or mitral valve diseases on visit 1, who died before 2005, and who had missing HF status on follow-up were excluded. The analysis included 4361 participants and was performed between June 2020 to August 2021. EXPOSURES Quantitative measures of cardiovascular (left ventricular mass index [LVMI], left ventricular ejection fraction [LVEF], left atrial [LA] diameter, and pulse pressure) and noncardiovascular (percent predicted forced expiration volume in 1 second [FEV 1 (percent predicted)], estimated glomerular filtration rate (eGFR), waist circumference, and hemoglobin A 1c [HbA 1c ] level) organ function. MAIN OUTCOMES AND MEASURES Incident HF, HFrEF, and HFpEF over 10-year follow-up. RESULTSThe 4361 participants had a mean (SD) age of 54 (13); 2776 (64%) were women; and there were 163 HFpEF and 146 HFrEF events. In multivariable models incorporating measures reflecting each organ system, factors associated with incident HFpEF included greater LA diameter (hazard

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Introduction: Food insecurity is common in the U.S. and disproportionately impacts Black Americans, but its association with risk of heart failure (HF) and coronary heart disease (CHD) is unclear. We evaluated the associations of economic food insecurity and proximity to unhealthy food options with risk of incident HF and CHD, and assessed the potential impact of diet quality and stress on these associations. Methods: Among 3,024 Black adult participants in the community-based Jackson Heart Study (JHS) without prevalent HF or CHD who attended visit 1 (2000-2004), the associations of economic food insecurity (receiving food stamps, self-reported ‘not enough money for groceries’) and proximity to unhealthy food stores (>2.5 unfavorable food stores [fast food restaurants, convenience stores] within 1 mile) with incident HF hospitalization and CHD were assessed using multivariable Cox proportional hazard models. Adjustment covariates included age, sex, BMI, hypertension, and diabetes in the initial model and diet quality (Healthy Eating Index) and perceived stress (total Global Perceived Stress score) in the extended model. Results: Mean age was 54±12 years, 34% were men, 630 (21%) were economically food insecure, and 1,512 (50%) had >2.5 unfavorable food stores within 1 mile. In multivariable models, economic food insecurity was associated with a heightened risk of incident HF and of incident CHD, which persisted with minimal attenuation after further adjustment for diet quality and perceived stress (Table). Limited physical food access was not associated with heightened risk of incident HF or CHD after accounting for demographics. Conclusions: Economic food insecurity, but not proximity to unhealthy food options, is associated with HF and CHD risk independent of traditional cardiovascular risk factors. Increased perceived stress and worse diet quality do not appear to account for these associations.